There is no shortage of schools of thought about psychotherapy, but if what you know about psychotherapy comes from novels or television, you might have some misguided notions about what really goes on in a practicing psychotherapist’s office. Psychotherapists are often portrayed as incompetent hacks, more disturbed than their clients. Some scenes are good, some bad, and others downright comical. There are numerous myths about psychotherapy that continue to show up in the written word and on the screen. Here are ten of the most common ones:

  1. People
    who go for psychotherapy are weak, mentally ill, or crazy.
    Untrue. Nowadays if you
    seek treatment, it’s viewed as a sign of resourcefulness. The average
    therapy client struggles with many of the same problems we all struggle
    with on a daily basis: relationships, self-doubt, confidence, self-esteem,
    work/life stress, life transitions, depression, and anxiety. The preferred
    designation for the person in therapy is “client,” not “patient,” for that
    very reason. Over my twenty-five years of experience, I’ve often said that
    the folks I treat in therapy are mentally healthier than some people
    walking the streets.
  2. Therapists
    sit behind desks taking notes while you lie on a couch.
    This is rarely the
    case. Trained clinicians know that the arrangement and distance between
    them and the client are critical for a safe and workable therapeutic
    alliance. Psychological or physical separation from the client can create
    subtle authority and intimidation and an inability on the client’s part to
    fully connect and disclose information pertinent to treatment. The typical
    therapeutic setting is much like your living room where both parties sit
    in comfortable chairs without barriers between them. Good therapists often
    ask if the distance is comfortable and refrain from taking notes until
    after the session so they can be present with clients.
  3. Psychotherapists
    and clients become best friends.
    There is no basis in the myth often seen in literature
    that you pay a psychotherapist to be nice to you and care for you. The
    therapeutic relationship is a psychologically intimate but strictly
    professional one. It’s the therapist’s absolute commitment and requirement
    of ethics and law that the relationship be limited to counseling sessions
    and necessary e-mail, phone, or text contacts. Clinicians who break the
    boundary between a professional relationship and friendship can lose their
    licenses for such infractions. The client’s name and personal story are
    strictly confidential. In an episode of the TV series The Sopranos, a
    serious ethical lapse occurred when one therapist revealed the name of
    another therapist’s client across a crowded table at a dinner party full
    of clinicians. Around the country the next day, the episode outraged
    clients and therapists because of this egregious ethical violation. Some
    fans even lost faith in their ability to maintain “belief” in the
    television program.
  4. Psychotherapy
    is mostly talk therapy.
    Therapy isn’t passive. Scenes in novels and TV shows
    where therapists just listen to clients vent, nod their heads in approval,
    and mirror back the same words are stereotypes. So are those cases in
    fiction where therapists interpret clients’ experiences for them instead
    of eliciting a client’s own interpretations. With today’s cutting-edge
    therapies, clinicians are trained in experiential and therapist-led
    modalities that engage both parties in an interactive collaborative
    process based on dialogue and the client’s active engagement in joint
    problem solving. Together psychotherapists and clients identify problems,
    set goals, and monitor progress sometimes with homework and reading
    assignments as part of the process.
  5. Psychotherapists
    have ready-made solutions for all of life’s problems.
    What is important in
    establishing the therapist-client alliance is not what the therapist
    thinks is important to bring about change but what the client thinks is
    important. A good therapist tailors treatment sessions around the needs of
    clients instead of plugging clients into ready-made formulas. In so doing,
    clinicians listen not just to the content of the story but for deeper
    themes and patterns that undergird the stories. This allows the
    professional to mirror feedback based on these emerging themes and
    patterns that can facilitate change, not just the repetitive words and
    phrases that clients supply.
  6. Psychotherapists
    blame a client’s problem on their upbringing.
    Despite the theatric
    antics of Dr. Phil, a well-trained therapist doesn’t blame or shame. They
    don’t blame clients or their parents. They bring an objective, bird’s-eye
    perspective to help clients see the water they’re swimming in, so they can
    take responsibility for their lives. Professional therapists never
    admonish, blame, or shame clients into change.
  7. Psychotherapists
    can prescribe medication.
    This is a common myth. The term “psychotherapist” is a
    broad umbrella that includes licensed social workers, licensed marriage
    and family therapists, licensed practicing counselors, and licensed
    psychologists. Although this practice has changed in some states,
    generally speaking psychotherapists are trained in the skill of helping
    clients work through their problems. Psychiatrists are medical doctors who
    usually limit their practices to prescribing and monitoring psychotropic
    medications while working with psychotherapists who conduct the actual
  8. Psychotherapy
    can solve problems in one or two sittings.
    While convenient for
    the writer to have a character “fixed” in a session or two, it doesn’t
    work that way in real life. The average session is around fifty-to-sixty
    minutes and the first session is basically an intake and getting
    acquainted session. To get to the heart of a problem, psychotherapy takes
    many more sessions over time. On the flipside, as in the Sopranos,
    psychotherapy rarely takes six or seven years. Generally speaking,
    something’s not working when a client works with the same therapist for
    excessively long periods of time. The average therapy course is three to
    four months.
  9. Psychotherapists
    believe that the personality is cemented by age five.
    The belief that you
    can’t teach old dogs new tricks is perhaps the biggest myth of all. When
    you read a novel in which a therapist says that personality is fixed by
    age five, it’s laughable and the story loses credibility. Neuroscientists
    have shown that the brain is malleable, and new MRI technology allows us
    to see this change. Some of the latest psychotherapy techniques utilize
    treatment based on neuroplasticity—the creation of new neural pathways in
    the brain and thus the potential for new beliefs and behaviors throughout
    life from womb to tomb.
  10. Psychotherapists
    make clients feel immediately better after each session.
    This scenario might be
    convenient for a storyline, but nothing is further from the truth. Clients
    are not cars, and therapists aren’t mechanics. Clients are active
    participants while therapists help them face and uncover whatever is
    bothering them. That process takes time and can be initially difficult and
    painful. Having feelings stirred up is part of the therapeutic process.
    When psychotherapists describe the healing trajectory, we often say
    sometimes things get worse before they get better. But skilled therapists
    are trained on how to lead clients through the storm into the calm.